October 10, 2011

Mark Brown blogging for Time to changePeople sometimes question why we need to focus on the 'stigma of mental illness' when we already have ideas like discrimination and prejudice. People ask; 'Aren't you just inventing a new kind of prejudice that only applies to people with mental health difficulties? Surely it's more important to change laws than change attitudes?'

If you want to look at why tackling the stigma of mental illness is important you have to ask yourself a question: Just why do people dislike, avoid, judge or otherwise make life difficult for people with mental health difficulties?

Negative ideas about mental health difficulty and the people who experience it seem to many to be natural facts, ideas that we absorb as correct without ever being conscious of their source. They feel like common sense. When we're asked where a particular  negative idea comes from we can always find examples of how that idea has been used but very rarely the point from which it originates.

Often people use the formulation 'Well, there are rules, laws and regulations about people with mental health difficulties doing this particular thing, therefore there must be a reason.'  If  asked what they know about those who experience mental health difficulties, people will extrapolate from what they know of laws, rules and regulations. Examples of this include; 'People with mental health difficulties must be dangerous or they wouldn't lock them up in hospital' and 'people with mental health difficulties must be worse at their jobs or there wouldn't be so many who are unemployed'.

But where do those ideas originate from and what's it got to do with stigma?

A stigma is an indelible taint or mark placed on you by a community or authority that not only tells you that you're wrong or undesirable, but also tells other people the same thing. As Catherine Amey writes in the winter edition of One in Four the idea of stigma is rooted in the wish to set a group within a society apart from others and to dictate how others should behave toward them. The word derives from the practice of branding criminals or other 'undesirables' so that they would carry a mark or scar for life to serve as a deterrent and punishment to the criminal and as a warning to others about their past. It was literally a way of marking people out as dangerous and to be avoided. As Catherine writes: “Stigma seems to serve a dual function: it protects people from individuals who pose a potential threat while saving them the trouble of thinking too hard.”

The stigma of mental illness carries on this tradition, even if it works very badly. It's like barnacles stuck to the bottom of a boat or that plug of hair and soap that blocks your plughole.  It's an accumulation of useless ideas stuck to people with mental health difficulties both individually and as a group or series of groups (there are different stigmatising ideas for different kinds of illness). Stigma is not just already having made up your mind about people with mental health difficulties.  It's already having made up your mind that mental health difficulties are always a negative in the world and that people with mental health difficulties are also a negative, too. 

Prejudice and discrimination may stem from stigma, but both primarily rest upon a set of fixed ideas about mental ill health. These are ideas that haven't kept pace with science, with the social model of disability, with political, economic and social change. Ideas that everyone knows, ideas that save you the trouble of thinking too hard. Ideas that seem to just float in the air that trap the lives of people with mental health difficulties like flies in amber. Ideas that don't even pay attention to the people that they refer to, that is, people with mental health difficulties. I mean, do you reckon it's ever possible to deter people from becoming unwell or that it ever helps to keep out of the way of people because they're experiencing difficulties?

It's important to challenge stigma because we need to shift common sense on mental health away from outmoded ideas that don't help anyone towards a more open space where ideas about mental health, and the actions that follow on from them, are defined by what we as people with mental health difficulties want and need.

Changing the attitudes that lie beneath structures is a natural partner to changing the structures themselves.  Ingrained stigma about 'those people' often only lasts until people begin to see 'those people' as 'us people'. 

Without continuing to challenging these ideas that everyone knows but no one owns, we'll never bring about the change for which many of us are hoping.

Mark Brown is editor of One in Four, the magazine for people with mental health difficulties, by people with mental health difficulties.

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